Manual therapy is the skilled application of passive movement to a joint either within (‘mobilization’) or beyond its active range of movement (‘manipulation’). This includes oscillatory techniques, high velocity low amplitude thrust techniques, sustained stretching and muscle energy techniques. Manual therapy can be applied to joints, muscles or nerves and the aims of treatment include pain reduction, increasing range and quality of joint movement, improving nerve mobility, increasing muscle length and restoring normal function. There are three paradigms for its therapeutic effects; physiological, biomechanical or physical, and psychological.
The physiological effects of manual therapy include the reduction of pain via the pain gate theory and stimulation of the descending inhibitory tracts. Indirectly, manual therapy can reduce pain via inhibition of muscle spasm which reduces tension on the periarticular structures, lowering intraarticular pressure, or reduces nociceptor activity.
